U.S. patent application number 12/506436 was filed with the patent office on 2010-01-28 for joint prosthesis for total lumbar arthroplasty by posterior approach.
This patent application is currently assigned to CLARIANCE. Invention is credited to Alain TORNIER.
Application Number | 20100023058 12/506436 |
Document ID | / |
Family ID | 41569330 |
Filed Date | 2010-01-28 |
United States Patent
Application |
20100023058 |
Kind Code |
A1 |
TORNIER; Alain |
January 28, 2010 |
JOINT PROSTHESIS FOR TOTAL LUMBAR ARTHROPLASTY BY POSTERIOR
APPROACH
Abstract
The total arthroplasty joint prosthesis includes connectors (2,
4) fixed in the pedicles Vp of the spinal levels by anchoring
screws (3), upper and lower connecting elements (5, 6) connecting
the connectors (2, 4) to each other, and guiding and damping
element (7) connecting the upper and lower connecting elements (5,
6), the guiding and damping element (7) and the upper and lower
connecting elements (5, 6) being constructed with relation to each
other so as to define at least one rotation and sliding axis C
situated at the level of the upper superjacent vertebra Va of the
instrumented segment Sr in order to limit the stresses on the
anchoring screws (3) ensuring fixation of the connectors (2) in the
superjacent vertebra Va.
Inventors: |
TORNIER; Alain;
(Saint-Ismier, FR) |
Correspondence
Address: |
YOUNG & THOMPSON
209 Madison Street, Suite 500
Alexandria
VA
22314
US
|
Assignee: |
CLARIANCE
Saint-Ismier
FR
|
Family ID: |
41569330 |
Appl. No.: |
12/506436 |
Filed: |
July 21, 2009 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
61083674 |
Jul 25, 2008 |
|
|
|
Current U.S.
Class: |
606/246 ;
606/264 |
Current CPC
Class: |
A61B 17/7049 20130101;
A61B 17/7043 20130101 |
Class at
Publication: |
606/246 ;
606/264 |
International
Class: |
A61B 17/70 20060101
A61B017/70 |
Claims
1. A total joint arthroplasty prosthesis allowing the guiding
elements of the superjacent Va and subjacent Vb lumbar vertebrae of
a spinal segment Sr of a vertebral column to be reconstructed,
characterized in that the prosthesis comprises connectors (2, 4)
fixed in pedicles Vp of the spinal levels by anchoring screws (3),
upper and lower connecting elements (5, 6) connecting the
connectors (2, 4) between each other, and guiding and damping means
(7) connecting said upper and lower connecting elements (5, 6),
said guiding and damping means (7) and said upper and lower
connecting elements (5, 6) being constructed with relation to each
other so as to define at least one rotation and sliding axis C
situated at the level of the superjacent upper vertebra Va of the
instrumented segment Sr in order to limit the stresses on the
anchoring screws (3) ensuring the fixation of connectors (2) in
said superjacent vertebra (Va).
2. The total joint arthroplasty prosthesis according to claim 1,
characterized in that the prosthesis comprises limitation means (8)
connecting the connectors (2, 4) between each other and allowing
the flexion extension and lateral inflexion movements around the
rotation and sliding axis C to be limited.
3. The total joint arthroplasty prosthesis according to claim 2,
characterized in that the limitation means (8) are constituted of a
cable (80) connecting the connectors (2, 4) between each other.
4. The total joint arthroplasty prosthesis according to claim 1,
characterized in that the guiding and damping means (7) are
constituted of a connection support (70) comprising an oblong
groove (71) inside of which is housed a guiding element (72)
cooperating with the connecting element (5, 6) and elastomer stops
(73) whose elastic deformations allow the displacements of said
guiding element (72) inside said oblong groove (71) to be limited
without constraint and guiding and fixation means cooperating with
the lower connecting element (6).
5. The total joint arthroplasty prosthesis according to claim 4,
characterized in that the guiding element (72) is constituted of a
first plate (74) integral with a hollow sleeve (75) on which a
second plate (76) comes, said guiding element (72) being connected
to the first upper connection element (5) through a clamping screw
(77) traversing the hollow sleeve (75) to cooperate with a nut
(78), said hollow sleeve (75) traversing the oblong groove (71) of
the connection support (70) such that its displacements are limited
by the elastic deformation of the elastomer stops (73).
6. The total joint arthroplasty prosthesis according to claim 4,
characterized in that the connection support (70) is connected to
the second lower connecting element (6) on the one hand by means of
a guiding device (79, 63) and on the other hand by means of a
blocking device (66, 65, 9).
7. The total joint arthroplasty prosthesis according to claim 1,
characterized in that the first upper connecting element (5) is
comprised of a central body (51) extending at each end by rods (52)
on which a slit bush with a spherical profile (53) respectively
slides intended to cooperate with each first connector (2), said
central body (51) being pierced by an oblong hole (54) for
cooperation with the guiding and damping means (7).
8. The total joint arthroplasty prosthesis according to claim 6,
characterized in that the second lower connecting element (6) is
constituted of a central part (60) laterally comprising extensions
(61), each presenting a fork-shaped end (62) provided to come
around the corresponding anchoring screw (3), said central part
(60) comprising a guiding device (63) and threaded bores (65) for
the placement and immobilization of the guiding and damping means
(7).
9. The total joint arthroplasty prosthesis according to claim 2,
characterized in that the first connectors (2) are each constituted
of a body (20) presenting a bore (21) for the passage of the
pedicle screw (3), a housing (22) for the reception of the first
upper connection element (5), a threaded bore (24) perpendicularly
culminating in a hole (25) and cooperating with a clamping screw
(27) for immobilizing the limitation means (8) when the latter are
introduced in the through hole (25), and a slot (26) traversing the
hole (25) and the bore (21) to culminate inside the housing (22) so
as to allow said housing to be deformed under a pressure force
generated by a clamping nut (34) during immobilization of said
first connector (2) on the corresponding pedicle screw (3).
10. The total joint arthroplasty prosthesis according to claim 2,
characterized in that the second connectors (4) are each
constituted of, on the one hand, a connection element (40) forming
a rod comprising, along a horizontal direction, a fork (41)
presenting an oblong opening (43) for its passage around the
pedicle screw (3), and extending along a perpendicular direction by
an anchoring rod (42) equipped with an end in the shape of a strip
and, on the other hand, a connecting ring (45) pierced in its
middle by a hole (46) for its placement around the same anchoring
screw (3), said connecting ring (45) is pierced by through holes
(49) allowing the limitation means (8) to be positioned and
immobilized.
11. The total joint arthroplasty prosthesis according to claim 7,
characterized in that the connecting ring (45) comprises lower
lateral edges (47) cooperating with the fork (41) such that the
ring (45) cannot pivot in rotation with relation to the anchoring
screw (3) when the nut (34) is tightened.
12. The total joint arthroplasty prosthesis according to claim 8,
characterized in that the connecting ring (45) comprises upper
lateral edges (48) that are disposed according to a direction
perpendicular to that of the lower lateral edges (47) for guiding
the second lower connecting element (6).
Description
[0001] The present invention relates to a total joint arthroplasty
prosthesis allowing the elements for guiding the superjacent and
subjacent lumbar vertebrae of a spinal segment to be reconstructed
with a center of rotation and means for limiting movements ensuring
the necessary stability of said vertebrae.
[0002] In certain cases of patients with degenerative lumbar spine
pathologies, such as joint stenosis or arthrosis, completely fusing
the superjacent and subjacent lumbar vertebrae of the spinal
segment is expected.
[0003] In young patients where the deterioration of the lumbar
vertebrae may be reversible, using dynamic stabilization devices
henceforth, especially as a first intention, is expected.
[0004] In cases of elderly patients where the deterioration of the
lumbar vertebrae are more severe and especially irreversible,
decompressing the spinal marrow and the nerve roots is expected,
necessitating the elimination of certain hypertrophied bone
elements. This technique generally leads to destabilization of the
spinal segment, requiring the superjacent and subjacent lumbar
vertebrae to be fused to each other.
[0005] It has been observed that fusion of the superjacent and
subjacent lumbar vertebrae to each other may, in certain cases,
present complications leading to the degeneration of the adjacent
spinal levels that are overstimulated due to said fusion.
[0006] The object of the total joint arthroplasty prosthesis
according to the present invention is, when destabilization of the
spine has been created, to be able to stabilize the affected spinal
segment Sr while protecting to term the other spinal levels from
risks of deterioration.
[0007] The total joint arthroplasty prosthesis according to the
present invention comprises connectors fixed in the pedicles Vp of
the spinal levels by anchoring screws, upper and lower connecting
elements connecting the connectors to each other, and guiding and
damping means connecting said upper and lower connecting elements,
said guiding and damping means and said upper and lower connecting
elements being constructed with relation to each other so as to
define at least one rotation and sliding axis C situated at the
level of the upper superjacent vertebra Va of the instrumented
segment Sr in order to limit the stresses on the anchoring screws
ensuring fixation of the connectors in said superjacent vertebra
Va.
[0008] The total joint arthroplasty prosthesis according to the
present invention comprises limitation means that connect the
connectors between each other and that enable the flexion extension
and lateral inflexion movements around the rotation and sliding
axis C to be limited.
[0009] The total joint arthroplasty prosthesis according to the
present invention comprises limitation means that are comprised of
a cable connecting the connectors between each other.
[0010] The total joint arthroplasty prosthesis according to the
present invention comprises guiding and damping means that are
comprised of a connecting support comprising an oblong groove
inside of which is housed a guiding element cooperating with the
connecting element and elastomer stops whose elastic deformations
enable the displacements of said guiding element inside said oblong
groove to be limited without constraint and guiding and fixation
means cooperating with the lower connecting element.
[0011] The total joint arthroplasty prosthesis according to the
present invention comprises a guiding element that is comprised of
a first plate integral with a hollow sleeve on which a second plate
is connected, said guiding element being connected to the first
upper connecting element through a clamping screw traversing the
hollow sleeve to cooperate with a nut, said hollow sleeve
traversing the oblong groove of the connecting support such that
its displacements are limited by the elastic deformation of the
elastomer stops.
[0012] The total joint arthroplasty prosthesis according to the
present invention comprises a connecting support that is connected
to the second lower connecting element on the one hand by means of
a guiding device and on the other hand by means of a blocking
device.
[0013] The total joint arthroplasty prosthesis according to the
present invention comprises a first upper connecting element that
is comprised of a central body extending at each end by rods on
which a slit bush with a spherical profile respectively slides
intended to cooperate with each first connector, said central body
being pierced by an oblong hole for cooperation with the guiding
and damping means.
[0014] The total joint arthroplasty prosthesis according to the
present invention comprises a second lower connecting element that
is comprised of a central part laterally comprising extensions,
each presenting a fork-shaped end provided to come around the
corresponding anchoring screw, said central part comprising a
guiding device and threaded bores for the positioning and
immobilization of guiding and damping means.
[0015] The total joint arthroplasty prosthesis according to the
present invention comprises first connectors that are each
comprised of a body presenting a bore for the passage of the
pedicle screw, a housing for the reception of the first upper
connecting element, a threaded bore perpendicularly culminating in
a hole and cooperating with a clamping screw for the immobilization
of limitation means when the latter are introduced into the through
hole and a slot traversing the hole and the bore to culminate
inside the housing so as to allow said housing to be deformed under
a pressure force generated by a clamping nut when the first
connector is immobilized on the corresponding pedicle screw.
[0016] The total joint arthroplasty prosthesis according to the
present invention comprises second connectors that are each
comprised of, on the one hand, a connection element forming a rod
comprising, along a horizontal direction, a fork presenting an
oblong opening for its passage around the pedicle screw, and
extending along a perpendicular direction by an anchoring rod
equipped with an end in the shape of a strip and, on the other
hand, a connecting ring pierced in its middle by a hole for its
positioning around the same anchoring screw, said connecting ring
is pierced with through holes allowing the positioning and
immobilization of the limitation means.
[0017] The total joint arthroplasty prosthesis according to the
present invention comprises a connecting ring comprising lower
lateral edges cooperating with the fork such that said ring may not
pivot in rotation with relation to the anchoring screw when the nut
is tightened.
[0018] The total joint arthroplasty prosthesis according to the
present invention comprises a connecting ring comprising upper
lateral edges that are disposed according to a direction
perpendicular to that of the lower lateral edges for guiding the
second lower connecting element.
[0019] The attached drawings, given by way of example, allow the
invention, the characteristics that the invention presents and the
advantages that the invention is likely to bring to be better
understood:
[0020] FIGS. 1 and 2 are views illustrating a spinal segment from a
vertebral column on which the total joint arthroplasty prosthesis
according to the present invention has been mounted on the spinal
level.
[0021] FIG. 3 is a blow-up perspective view representing the
different elements constituting the total joint arthroplasty
prosthesis according to the present invention.
[0022] FIG. 4 is a perspective view showing the assembly of
different elements constituting the total joint arthroplasty
prosthesis according to the present invention.
[0023] FIG. 5 is a view illustrating a spinal segment of a
vertebral column on which the total joint arthroplasty prosthesis
according to the present invention has been assembled on at least
two spinal levels.
[0024] FIG. 6 is blow-up perspective view representing the
different elements constituting the total joint arthroplasty
prosthesis to connect at least two spinal levels according to the
present invention.
[0025] FIG. 7 is perspective view showing the assembly of the
different elements constituting the total joint arthroplasty
prosthesis to connect at least two spinal levels according to the
present invention.
[0026] FIGS. 1 to 4 show an instrumented spinal segment Sr of a
vertebral column wherein certain vertebrae, more particularly the
superjacent Va and subjacent Vb lumbar vertebrae, are connected to
each other by a total joint arthroplasty prosthesis 1.
[0027] The joint prosthesis 1 comprises, on the one hand, first
connectors 2 through an anchoring screw 3 fixed in the pedicles Vp
of the superjacent lumbar vertebra Va and, on the other hand,
second connectors 4 through other anchoring screws 3 fixed in the
pedicles Vp of the subjacent lumbar vertebra Vb.
[0028] The joint prosthesis 1 comprises a first upper connecting
element 5 allowing the first connectors 2 integral with the
pedicles Vp of the superjacent lumbar vertebra Va to be connected
to each other.
[0029] The joint prosthesis 1 comprises a second lower connecting
element 6 allowing the second connectors 4 integral with the
pedicles Vp of the subjacent lumbar vertebra Vb to be connected to
each other.
[0030] The joint prosthesis 1 comprises guiding and damping means 7
connecting the first upper connecting element 5 with the second
lower connecting element 6 and ensuring controlled flexion
extension and lateral inflexion movements of the superjacent Va and
subjacent Vb lumbar vertebrae.
[0031] The guiding and damping means 7 and the upper and lower
connecting elements 5, 6 are constructed with relation to each
other so as to define at least one rotation and sliding axis C
situated at the level of the upper superjacent vertebra Va of the
instrumented segment Sr in order to limit the stresses on the
anchoring screw 3 ensuring fixation of connectors 2 in said
superjacent vertebra Va.
[0032] The joint prosthesis 1 comprises limitation means 8
connecting the first connectors 2 with the corresponding second
connectors 4 ensuring limitation of the flexion extension and
lateral inflexion movements of the superjacent Va and subjacent Vb
lumbar vertebrae. The limitation means 8 connecting the connectors
2, 4 between them allow the flexion extension and lateral inflexion
movements around the rotation and sliding axis C of the joint
prosthesis 1 to be limited.
[0033] The joint prosthesis 1 comprises double-threaded pedicle
anchoring screws 3 that are known in themselves and constituted of
a longitudinal body 30 presenting a threaded part 31 intended for
the anchoring of said screw into the bone body of the pedicles Vp
of each superjacent and subjacent lumbar vertebra Va, Vb of the
spinal segment Sr to be instrumented.
[0034] The longitudinal body 30 comprises, in the extension of the
threaded part 31, a clamping head 32 integral with a threaded
cylindrical profile 33 allowing a clamping nut 34 to be
positioned.
[0035] Also, the pedicle screws 3 may be cannulated with the
lateral openings 35 allowing biological cement intended to improve
the anchoring in each superjacent and subjacent lumbar vertebra Va,
Vb of the spinal segment Sr to be instrumented to be injected.
[0036] The first connectors 2 are each constituted of a body 20
presenting a bore 21 for the passage of the threaded cylindrical
profile 33 of the pedicle screw 3 along a perpendicular direction
and, offset laterally to said bore, a housing 22 with a spherical
profile cooperating with the first upper connecting element 5.
[0037] The first upper connecting element 5 is constituted of a
central body 51 extending at each end by rods 52 on which
respectively slide a slit bush with a spherical profile 53 intended
to cooperate with the housing 22 of each connector 2 and allow the
angular positioning of said upper connecting element 5 with
relation to said connector. The central body 51 of the first upper
connecting element 5 is pierced by an oblong hole 54 wherein the
longitudinal axis is perpendicular to that of rods 52.
[0038] The body 20 of each first connector 2 is pierced vertically
by a threaded bore 24 culminating perpendicularly in a hole 25
traversing said body. The threaded bore 24 cooperates with a
clamping screw 27 allowing the limitation means 8 to be immobilized
when the latter are introduced into the through hole 25.
[0039] The means for limiting 8 the flexion extension and lateral
inflexion movements are constituted of a cable 80 formed for
example by a central strand around which six other strands are
twisted.
[0040] The body 20 of each first connector 2 presents a slot 26
traversing the hole 25 and the bore 21 to culminate inside the
housing 22 so as to enable said housing to be deformed under a
pressure force generated by the clamping nut 34 when said connector
is immobilized on the corresponding pedicle screw 3.
[0041] The second connectors 4 are each comprised of a connection
element forming a rod 40 comprising, along a horizontal direction,
a fork 41 extending along a perpendicular direction by a backer rod
42.
[0042] The fork 41 presents an oblong opening 43 that cooperates
with the threaded cylindrical profile 33 of each anchoring screw 3,
while the backer rod 42 presents an end in the shape of a strip
that is supported against the external bone part of the
corresponding vertebra along a direction that is substantially
parallel to that of the threaded part 31 of the anchoring screw 3
in order to reinforce the pedicle anchoring and resist being out of
plumb.
[0043] The oblong opening 43 of the fork 41 presents a profile that
is adapted around the clamping head 32 of the anchoring screw 3 so
that the connection element 40 forming a rod cannot be driven in
rotation when the nut 34 is tightened.
[0044] The second connectors 4 each comprise a connecting ring 45
pierced in its middle by a hole 46 for its placement around the
threaded cylindrical profile 33 of the anchoring screw 3. The
connecting ring 45 comprises a lower face supported on fork 41.
[0045] The lower face comprises lateral edges 47 cooperating with
the external edges of each branch constituting the fork 41 such
that the ring 45 cannot pivot in rotation with relation to the
anchoring screw 3 when the nut 34 is tightened.
[0046] The lateral edges 47 of the lower face of each connecting
ring 45 are respectively pierced by a through hole 49 allowing the
cable 80 of the limitation means 8 to be positioned and
immobilized.
[0047] The connecting ring 45 comprises an upper face equipped with
lateral edges 48 that are disposed along a direction perpendicular
to that of the lateral edges 47 of the lower face.
[0048] The upper face of the connecting ring 45 of each connection
element 40 forming a rod is provided to cooperate with, before the
nut 34 is tightened, the second lower connecting element 6.
[0049] The second lower connecting element 6 is constituted of a
central part 60 laterally comprising extensions 61, each presenting
an end in the form of a fork 62. The branches of the fork 62 of
each extension 61 are provided to come around the threaded
cylindrical profile 33 of the corresponding anchoring screw 3 while
being laterally guided, before the nut 34 is tightened, by the
lateral edges 48 of the upper face of the connecting ring 45.
[0050] The central part 60 of the second lower connecting element 6
laterally comprises, along a direction perpendicular to that of
extensions 61, a guiding device 63 whose profile may be, for
example, a dovetail.
[0051] The central part 60 is pierced between the lateral edges of
the guiding device 63 by two threaded bores 65 respectively
cooperating with a clamping screw 66 for immobilizing in
translation a connection support 70 belonging to the guiding and
damping means 7 allowing the first upper connection element 5 to be
connected to the second lower connecting element 6.
[0052] The connection support 70 comprises in its middle an oblong
groove 71 inside of which is housed a guiding element 72 and, on
each side of the latter, elastomer stops 73 whose elastic
deformations allow the displacements of said guiding element 72
inside said oblong groove 71 to be limited without constraint.
[0053] The guiding element 72 is constituted under the connection
support 70 of a first plate 74 integral with a hollow sleeve 75
traversing the oblong groove 71 and on which a second plate 76 is
fitted above said connecting support 70.
[0054] The guiding element 72 is connected to the central body 51
of the first upper connection element 5 through a clamping screw 77
traversing the hollow sleeve 75 and the oblong hole 54 to cooperate
with a nut 78.
[0055] The connection support 70 is connected to the central part
60 of the second lower connecting element 6 by a guiding device 79
whose profile, complementary to that of the guiding device 63,
allows said connection support 70 to slide in the central part 60
of the second lower connecting element 6.
[0056] The connection support 70 is pierced by two holes 9, each
traversed by a clamping screw 66 cooperating with the threaded
bores 65 for the fixation of said connection support 70 on the
central part 60 of the second lower connecting element 6.
[0057] FIGS. 5 to 7 show the assembly and mounting of the total
joint arthroplasty prosthesis 1, for example, on two spinal levels
Va, Vb and Vc of a spinal segment Sr to correct. Vertebrae Va and
Vb are extreme vertebrae of the spinal segment Sr to be
instrumented, while vertebra Vc is found between said vertebrae Va
and Vb.
[0058] In the same manner as the previous, first and second
connectors 2, 4, each connected by upper and lower connecting
elements 5, 6 of the total joint arthroplasty prosthesis 1, are
respectively fixed on pedicles Vp of vertebrae Va, Vb through
anchoring screws 3.
[0059] At the level of the pedicles Vp of the intermediate vertebra
Vc are fixed, by means of anchoring screws 3, other connectors 4
that are identical to those fixed in the pedicles of vertebra
Vb.
[0060] Connectors 4 of vertebra Vc are connected between each other
by a median connecting element 6 similar in part to that connecting
the connectors 4 of vertebra Vb. The median connecting element 6 of
the vertebra Vc is mainly distinguished from that described
previously in that the central part 60 comprises, between
extensions 61, a lateral skirt 64 pierced in its middle by an
oblong hole 67.
[0061] This lateral skirt 64 presents the same characteristics and
advantages as the central body 51 of the first upper connection
element 5 in order to allow the fixation of the guiding element 72
of the guiding and damping means 7 through a clamping screw 77
traversing the hollow sleeve 75 and the oblong hole 67 to cooperate
with the nut 78.
[0062] This lateral skirt 64 of the median connecting element 6
enables another guiding and damping means 7 to be placed and held,
means 7 are identical to those described previously except they are
between spinal levels Vc, Vb.
[0063] Thus, the upper connection element 5 fixed on vertebra Va is
connected to the median connecting element 6 of vertebra Vc by
guiding and damping means 7 similar to those described previously,
while the median connecting element 6 is connected to the lower
connecting element 6 of vertebra Vb by other guiding and damping
means 7.
[0064] Also, connectors 2 and 4 of spinal levels Va, Vc and
connectors 4 of spinal levels Vc, Vb are respectively connected by
first and second cables 80 constituting the means 8 for limiting
the flexion extension and lateral inflexion movements.
[0065] Thus, the total joint arthroplasty prosthesis 1 integral
with superjacent and subjacent vertebrae Va and Vb or vertebrae Va,
Vc, Vb allows, when the spine has been destabilized, the spinal
segment Sr to be able to be stabilized while protecting the other
spinal levels from deterioration.
[0066] In fact, the total joint arthroplasty prosthesis 1 enables,
by its structure and the various elements making it up, the guiding
elements of the superjacent Va and subjacent Vb lumbar vertebrae of
a spinal segment Sr of a vertebral column to be reconstructed.
[0067] In addition, it must be understood that the previous
description was only given by way of example and that it in no way
limits the field of the invention from which one will not depart by
replacing the details of embodiment described by any other
equivalents.
* * * * *